The Medication Combos That Send People to the ER
From Talking With Docs.
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Could the medications you already take be the reason you end up in the emergency room? Studies have traced up to about 1 in 10 ER visits back to a medication problem. Not an allergy, but a side effect or a drug interaction, often between prescriptions that are each perfectly reasonable on their own.
In this episode of Talking With Docs, Dr. Brad Weening and Dr. Paul Zalzal are joined by Dr. David Scott, a general internist in Oakville who diagnoses patients in the ER and prescribes their medications. He walks through the common drug interactions he sees in real patients: two antibiotics, two painkillers and one very common heartburn medication.
Drug-drug interactions happen in two main ways. One drug can change how much of another drug ends up in your blood, by slowing down how it's broken down or cleared. Or two drugs can push the body in the same direction at the same time, like alcohol and an opioid, which both slow the brain. The risk climbs as we get older and take more medications, often from several prescribers.
New to the topic? Watch our episode on the Beers Criteria, the medications that can hurt you as you age: https://youtu.be/PmNy2Na1Wso
You'll learn:
What a "medication adverse event" is, and how it differs from a drug allergy
The two ways drugs interact with each other
Why older adults on several medications are at the highest risk
Why Septra (trimethoprim-sulfamethoxazole) can cause dangerously low blood sugar with some diabetes pills
How Septra can raise potassium in people taking ACE inhibitors or ARBs for blood pressure
How clarithromycin blocks a "pump" in your gut that keeps drug levels steady
Why clarithromycin can raise levels of digoxin, warfarin and some seizure medications within hours
Why codeine does nothing until your body converts it into morphine
How your genes decide whether codeine works for you, or works far too well
Why tramadol can behave so differently from one person to the next
How proton pump inhibitors (pantoprazole and the other "-prazoles") can lower magnesium, especially with certain diuretics
The muscle twitches and cramps that can be a clue to low magnesium
The one question to ask every time you're prescribed something new
The Septra examples aren't just textbook theory. Large Ontario studies of older adults have found a several-fold higher risk of hospitalization for low blood sugar or high potassium when this antibiotic is added to certain diabetes or blood pressure medications. It's still a very useful antibiotic. It just means the prescriber should check what you're already on first.
The painkiller story is just as surprising. Codeine and tramadol both depend on a liver enzyme called CYP2D6 to become fully active, and the amount of that enzyme you have is written in your genes. Some people get almost no pain relief at all. Others convert so much that an "ordinary" dose hits them far harder than intended. If codeine never worked for you but did for a friend, this may be why.
The good news is that protecting yourself is simple. Keep an up-to-date list of every medication you take and bring it to every visit, especially at a walk-in clinic or the ER. Fill your prescriptions at the same pharmacy, so its interaction checker can see everything. And ask the person prescribing: "Will this interact with any of my other medications?"
Have you ever had a drug interaction you weren't expecting? Tell us in the comments.
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https://podcasts.apple.com/ca/podcast/talking-with-docs-podcast/id1799242189
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- TWD Podcast
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🛑 DISCLAIMER: This content is for educational purposes only and should not replace professional medical advice. Medications and drug interactions affect people differently, and decisions about antibiotics, pain medications, acid-reducing medications and any other prescription or non-prescription drug should be individualized based on your health history, current medications and circumstances. Never stop or change a medication without talking to your physician or pharmacist. Always follow the guidance provided by your physician, pharmacist, and healthcare team. Full disclaimer at talkingwithdocs.com.
#DrugInteractions #MedicationSafety #Polypharmacy #SideEffects #Pharmacist #Codeine #Tramadol #Antibiotics #Septra #Clarithromycin #PPI #SeniorHealth #EmergencyRoom #TalkingWithDocs #DoctorExplains
Could the medications you already take be the reason you end up in the emergency room? Studies have traced up to about 1 in 10 ER visits back to a medication problem. Not an allergy, but a side effect or a drug interaction, often between prescriptions that are each perfectly reasonable on their own.
In this episode of Talking With Docs, Dr. Brad Weening and Dr. Paul Zalzal are joined by Dr. David Scott, a general internist in Oakville who diagnoses patients in the ER and prescribes their medications. He walks through the common drug interactions he sees in real patients: two antibiotics, two painkillers and one very common heartburn medication.
Drug-drug interactions happen in two main ways. One drug can change how much of another drug ends up in your blood, by slowing down how it's broken down or cleared. Or two drugs can push the body in the same direction at the same time, like alcohol and an opioid, which both slow the brain. The risk climbs as we get older and take more medications, often from several prescribers.
New to the topic? Watch our episode on the Beers Criteria, the medications that can hurt you as you age: https://youtu.be/PmNy2Na1Wso
You'll learn:
What a "medication adverse event" is, and how it differs from a drug allergy
The two ways drugs interact with each other
Why older adults on several medications are at the highest risk
Why Septra (trimethoprim-sulfamethoxazole) can cause dangerously low blood sugar with some diabetes pills
How Septra can raise potassium in people taking ACE inhibitors or ARBs for blood pressure
How clarithromycin blocks a "pump" in your gut that keeps drug levels steady
Why clarithromycin can raise levels of digoxin, warfarin and some seizure medications within hours
Why codeine does nothing until your body converts it into morphine
How your genes decide whether codeine works for you, or works far too well
Why tramadol can behave so differently from one person to the next
How proton pump inhibitors (pantoprazole and the other "-prazoles") can lower magnesium, especially with certain diuretics
The muscle twitches and cramps that can be a clue to low magnesium
The one question to ask every time you're prescribed something new
The Septra examples aren't just textbook theory. Large Ontario studies of older adults have found a several-fold higher risk of hospitalization for low blood sugar or high potassium when this antibiotic is added to certain diabetes or blood pressure medications. It's still a very useful antibiotic. It just means the prescriber should check what you're already on first.
The painkiller story is just as surprising. Codeine and tramadol both depend on a liver enzyme called CYP2D6 to become fully active, and the amount of that enzyme you have is written in your genes. Some people get almost no pain relief at all. Others convert so much that an "ordinary" dose hits them far harder than intended. If codeine never worked for you but did for a friend, this may be why.
The good news is that protecting yourself is simple. Keep an up-to-date list of every medication you take and bring it to every visit, especially at a walk-in clinic or the ER. Fill your prescriptions at the same pharmacy, so its interaction checker can see everything. And ask the person prescribing: "Will this interact with any of my other medications?"
Have you ever had a drug interaction you weren't expecting? Tell us in the comments.
🎧 Listen on Your Favourite Platforms:
Spotify:
https://open.spotify.com/show/3OFxEjictC41CCS1z2AVKe
Apple Podcast:
https://podcasts.apple.com/ca/podcast/talking-with-docs-podcast/id1799242189
YouTube Music:
- TWD Podcast
👕 Shop Our MERCH:
https://www.spreadshirt.ca/shop/user/talking+with+docs
❤️ Support Oakville Hospital:
https://oakvillehospitalfoundation.com/
📱 Follow Us:
TikTok:
https://www.tiktok.com/@talkingwithdocs
Instagram:
https://www.instagram.com/talkingwithdocs/?hl=en
🛑 DISCLAIMER: This content is for educational purposes only and should not replace professional medical advice. Medications and drug interactions affect people differently, and decisions about antibiotics, pain medications, acid-reducing medications and any other prescription or non-prescription drug should be individualized based on your health history, current medications and circumstances. Never stop or change a medication without talking to your physician or pharmacist. Always follow the guidance provided by your physician, pharmacist, and healthcare team. Full disclaimer at talkingwithdocs.com.
#DrugInteractions #MedicationSafety #Polypharmacy #SideEffects #Pharmacist #Codeine #Tramadol #Antibiotics #Septra #Clarithromycin #PPI #SeniorHealth #EmergencyRoom #TalkingWithDocs #DoctorExplains
